| NPI | 1902545437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO LPC.0020916) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO LPCC.0019410) |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2025-07-18 |